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Medicare Policy Contradicts Preferred Treatment For Precancerous Skin Conditions, Westwood Squibb Center For Dermatology Research Reports

on," he said.

So while a doctor in Tallahassee may not remove a lesion on the first visit, his colleague a few miles over the state line in Georgia may. Texas, Maryland and New Mexico also have adopted the Florida policy. Colorado limits the number of procedures a physician can perform on the first visit.

Members of the Academy are meeting in Washington, D.C. later this month to review the data about actinic keratosis and squamous cell carcinoma to assess the impact of the rules.

Dr. Alan Fleischer, a co-author of the Westwood Squibb Center study, pointed out that technically, Medicare is not prohibiting doctors from removing lesions on the first visit if that is called for. "But the fact that they will not reimburse you makes it reality," he said. "If Medicare stopped paying for all gall bladder removals, how many gall bladder removals would there be." The researchers based their study on an analysis of all initial visits to doctors for actinic keratosis in 1993 and 1994, collected as part of the National Ambulatory Medical Care Survey.

In recent years, Medicare has been making it harder for doctors to perform certain medical procedures in order to reduce Medicare costs. The policy is intended to reduce the instances in which doctors perform unnecessary procedures.

To see if this might be the case with actinic keratosis, the study looked at how doctors treat other skin conditions for which minor surgery and other procedures are available, such as warts, psoriasis and acne. It found that medical procedures were used far less frequently, said Fleischer, associate professor of dermatology at Wake Forest. .

"We wanted to see if it's just 'greedy doctors' charging for procedures because they can," he said. "We found that the other conditions had procedures available but they were not used as much, and this goes to the point that there really is something beneficial to removing lesions over using
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Contact: Bob Conn, Mark Wright or Jim Steele
rconn@wfubmc.edu
336-716-4587
Wake Forest University Baptist Medical Center
1-Jan-1999


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